(a) In this title the following words have the meanings indicated. (b) "Alzheimer's disease" means a progressive brain disease diagnosed as Alzheimer's disease by the licensed attending physician of the insured or certificate holder and confirmed by a second opinion of a licensed physician. (c) "Applicant" means: (1) for an individual policy or contract of long-term care insurance, the individual who seeks to contract for benefits; or (2) for a group policy of long-term care insurance, the proposed certificate holder. (d) "Carrier" means an insurer, nonprofit health service plan, health maintenance organization, or preferred provider organization. (e) "Certificate" means a certificate that is issued under a group policy of long-term care insurance if the certificate is delivered or issued for delivery in the State and covers individuals who reside in the State. (f) (1) "Long-term care insurance" means an individual or group policy, contract, certificate, or rider that: (i) is issued, delivered, or offered by a carrier; (ii) is advertised, marketed, offered, or designed to provide coverage for at least 24 consecutive months for each covered individual on an expense-incurred, indemnity, prepaid, or insured basis; and (iii) provides one or more necessary or appropriate diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services in a setting other than an acute care unit of a hospital. (2) "Long-term care insurance" includes any product that is advertised, marketed, or offered as long-term care insurance. (3) "Long-term care insurance" does not include: (i) a policy, contract, certificate, or rider that is offered primarily to provide: 1. basic Medicare supplement coverage; 2. hospital confinement indemnity coverage; 3. basic hospital expense or medical surgical expense coverage; 4. disability income protection coverage; 5. accident-only coverage; 6. specified disease or specified accident coverage; or 7. skilled nursing care; (ii) a life insurance policy that: 1. accelerates the death benefit specifically for: A. one or more of the qualifying events of terminal illness; B. a medical condition that requires extraordinary medical intervention; or C. permanent institutional confinement; 2. provides the option of lump-sum payments for the benefits listed in item 1 of this item; or 3. does not make benefits or eligibility for benefits conditional on receipt of long-term care; or (iii) a certificate that is issued under an out-of-state employer group contract. (g) "Loss ratio" means the ratio of losses incurred to premiums earned on policies that are issued, delivered, or renewed in the State. (h) "Out-of-state employer group contract" means a group contract that: (1) is entered into with an employer in a state other than this State; and (2) is issued directly to an employer under the laws of that employer's state. (i) "Preexisting condition" means a condition for which medical advice or treatment was recommended by or received from a provider of health care services within 6 months before the effective date of coverage of the insured or certificate holder.
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